THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Saturday, April 22, 1995 TAG: 9504220315
SECTION: FRONT PAGE: A4 EDITION: FINAL
SOURCE: THE WASHINGTON POST
DATELINE: WASHINGTON LENGTH: Medium: 55 lines
Medicare has been charged as much as $600 an hour for therapy services to patients in nursing homes, even though the average hourly rate for physical, occupational or speech therapists employed by hospitals and nursing homes is only $12 to $25 an hour, according to the General Accounting Office.
``We found widespread examples of overcharges to Medicare for therapy services to nursing home patients,'' the GAO said in a report to Rep. John D. Dingell, D-Mich. It attributed the ``extraordinary markups on therapy services'' to ``regulatory ambiguity and weaknesses in Medicare's payment rules.''
The findings were based on a survey of Medicare records in Arkansas, Georgia, Florida and North Carolina.
``Waste, fraud and abuse in government programs are all too often committed by private contractors overbilling taxpayers and gaming the system,'' Dingell said.
In a response included in the GAO report, the Department of Health and Human Services, which administers Medicare, did not dispute that ``nursing homes may be claiming substantial amounts of unallowable or unreasonable costs.''
However, HHS said it is not clear yet whether Medicare actually paid all the bills; the GAO report is based on what Medicare was billed for the therapy services, but Medicare's actual payments are based on ``audited reasonable costs,'' which are often much lower than the charges billed.
Until payment records are studied carefully to determine whether the charges were actually paid, the high billings should be termed ``a potential problem, rather than an actual problem based on actual findings,'' HHS said.
``We do not agree'' with the department's position, the GAO said.
It said field work and discussions with Medicare auditors and processing contractors indicated that many of the inflated charges ``get paid in full by the program.''
The billing abuses discussed in the GAO report were charges to Medicare for patients who were recuperating in a skilled nursing facility after a hospital stay. Some nursing homes employ their own therapists, but 75 percent of all skilled nursing facilities rely on rehabilitation agencies - also termed outpatient therapy agencies - to provide services, the GAO said. Sometimes it was the nursing home that billed the high charges, sometimes the rehabilitation agency.
The GAO said Medicare rules on ``reasonableness'' of charges for therapy services are ``so vague that there is almost no limit on the type and amount of costs that Medicare will reimburse.'' Moreover, Medicare has issued no guidelines on how much should be paid for occupational or speech therapy. by CNB